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DOT Exam Oakstone Course > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Is use of a first generation antihistamine (like Benadryl) disqualifying?

A

-not always, but must disqualify if it interferes with safe driving

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2
Q

Can a driver who uses continuous supplemental oxygen be qualified under certain circumstances?

A

No. A driver who needs continuous oxygen has significant underlying dz.
Risk of equipment malfunction can lead to a sudden change in physican and/or mental status.

NOBODY who uses continuous supplemental oxygen can be certified.

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3
Q

When is a driver with active tuberculosis be certified?

A

-Driver is not contagious and has completed streptomycin therapy without it affecting hearing or balance
-tolerates anti-tubercular therapy well if they haven’t finished the therapy yet
-compliant with drug therapy
-no side effects that interfere with safe driving
-etiologies is confirmed

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4
Q

If a driver with active tuberculosis is certified, for what period of time can you recertify them?

A

-Can certify for up to two years
-certify on case-by-case basis; get any needed additional medical tests

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5
Q

What makes a driver with active tuberculosis ineligible for certification?

A

-Driver has advanced TB, resp insufficiency, and cannot meet pulmonary function test criteria
-driver has chronic TB
-noncompliance with tubercular therapy
-has not completed streptomycin therapy
-residual eighth cranial nerve damage affecting balance and/or hearing to an extent that interferes with safe driving

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6
Q

What is important about streptomycin?

A

-It can cause damage to the eighth cranial nerve and subsequent deficits in hearing and balance
-user streptomycin indicates more severe form of TB

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7
Q

For what period of time can a driver with tuberculosis who is eligible be recertified? What criteria must be met in order for the driver to be recertified?

A

-Can be certified for up to two years
-certification is on case-by-case basis

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8
Q

What do you do if the driver has a positive PPD test?

A

-Driver needs a chest x-ray. If it is normal, no further action is required.
-Chest x-ray suggests pulmonary TB findings, further evaluation is needed.

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9
Q

What is atypical tuberculosis?

A

Same symptoms and range of illness as tuberculosis, but is not contagious

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10
Q

When can a driver with atypical tuberculosis be certified?

A

-etiology confirmed
-condition stable
-treatment safe and effective

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11
Q

For what period of time can a driver with atypical tuberculosis be certified? What follow-up does this driver need?

A

-Recertify every two years
-driver needs pulmonary function testing if they have symptoms of extensive pulmonary dysfunction, weakness, fatigue

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12
Q

What would cause a driver with atypical tuberculosis to be disqualified?

A

Driver has any of the following:
-extensive pulmonary dysfunction
-weakness
-fatigue
-adverse reaction to medical treatment

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13
Q

What is bronchiectasis?

A

Destruction and widening of large airways

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14
Q

When can a driver with acquired bronchiectasis be certified?

A

-etiology confirmed
-condition stable
-treatment safe and effective

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15
Q

For what period of time can a driver with acquired bronchiectasis be certified? What follow-up does this driver need?

A

-Recertify every two years
-driver should take measures to prevent additional infection; for example, should get influenza and pneumococcal vaccines

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16
Q

What would cause a driver with acquired bronchiectasis to be disqualified?

A

-Temporarily disqualify if driver is experiencing severe infection, or if driver has hemoptysis of volume 250 mL or greater

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17
Q

Suppose a driver may have a chest wall deformity, such as kyphosis scoliosis, kyphosis, massive obesity, pectus excavatum, ankylosing spondylitis, etc. What test must you give to the driver with a chest wall deformity before they can be certified?

A

-Driver must have near-normal pulmonary function tests to be certified

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18
Q

When can a driver with a chest wall deformity be certified?

A

When can a driver with a chest wall deformity be certified?

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19
Q

What kind of follow-up does a driver with a chest wall deformity require?

A

-Must have pulmonary function testing
-if FEV1 < 65% of predicted value, ABG should be obtained

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20
Q

When is a driver with chest wall deformity not eligible to be certified?

A

-Hypoxemia addressed
-chronic respiratory failure
-history of continuing cough with cost syncope

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21
Q

All smokers over age ____ should have pulmonary function testing done by spirometry.

A

35

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22
Q

When are patients with chronic obstructive lung disease eligible for certification?

A

-Etiology is confirmed
-treatment safe and effective
-condition does not pose a risk to the safety of the driver and to the public

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23
Q

For what period of time can a patient with chronic obstructive lung disease be certified?

A

-May be certified for up to two years

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24
Q

For what period of time can a patient with chronic obstructive lung disease be certified?

A

May be certified for up to two years

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25
Q

What kind of follow-up does a driver with chronic obstructive lung disease require?

A

-Perform pulmonary function testing
-considerable pulmonary function testing with difficulty breathing at rest
-if FEV1 < 65% of predicted value, ABG should be obtained

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26
Q

When is a driver with chronic obstructive lung disease not eligible to be certified?

A

-Hypoxemia at rest
-chronic respiratory failure
-continuing cugh with cough syncope

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27
Q

When are patients with a cold eligible for certification?

A

-Etiology is confirmed
-treatment safe and effective
-condition does not pose a risk to the safety of the driver and to the public

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28
Q

For what period of time can a patient with a cold be certified?

A

-May be certified for up to two years

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29
Q

What kind of follow-up does a driver with a cold require?

A

-Perform pulmonary function testing
-considerable pulmonary function testing with difficulty breathing at rest
-if FEV1 < 65% of predicted value, ABG should be obtained

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30
Q

When is a driver with a cold not eligible to be certified?

A

-Hypoxemia at rest
-chronic respiratory failure
-continuing cugh with cough syncope

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31
Q

When are patients with cystic fibrosis eligible for certification?

A

-Treatment is safe and effective
-as the medical examiner, you believe the condition doesn’t pose a risk to safety of driver of the public
-driver complies with continuous medical monitoring by a specialist

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32
Q

For what period of time can a patient with cystic fibrosis be certified?

A

-may certify for maximum of two years, but if driver needs frequent monitoring, then certify for one year

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33
Q

What kind of follow-up does a driver with cystic fibrosis require?

A

-May certify for two years maximum, but for only one year if driver needs frequent monitoring
-if FEV1 < 65% of predicted value, ABG should be obtained

34
Q

When is a driver with cystic fibrosis not eligible to be certified?

A

-Hypoxemia at rest
-chronic respiratory failure
-history continuing cough with cough syncope
-spirometry parameters are not met
-unstable condition
-unstable treatment regimen

35
Q

When are patients with interstitial lung disease eligible for certification?

A

-etiology confirmed
-Treatment is safe and effective
-as the medical examiner, you believe the condition doesn’t pose a risk to safety of driver of the public

36
Q

For what period of time can a patient with interstitial lung disease be certified?

A

-Maximum of two years

37
Q

What kind of follow-up does a driver with interstitial lung disease require?

A

-Two year maximum certification
-get additional studies if x-ray shows extensive abnormalities and/or dyspnea
-perform PFTs to follow guidelines listed in additional pulmonary function tests sections
- if FEV1 < 65% of predicted value, ABG should be obtained

38
Q

When is a driver with interstitial lung disease not eligible to be certified?

A

-Hypoxemia addressed
-chronic respiratory failure
-history of continuing cough with cough syncope

39
Q

When are patients with pneumothorax eligible for certification?

A

-check chest x-ray to ensure complete resolution of the pneumothorax; if there is air in the pleural space or there is pneumomediastinum, additional time away from work is needed
-driver must be asymptomatic without chest pain or dyspnea
-no disqualifying underlying lung disease
-confirmed resolution of the single spontaneous pneumothorax
-successful pleurodesis and meets acceptable pulmonary parameters

40
Q

For what period of time can a patient with pneumothorax be certified?

A

Maximum of two years

41
Q

What kind of follow-up does a driver with pneumothorax require?

A

-Two-year max certification
-chest x-ray required

42
Q

When is a driver with pneumothorax not eligible to be certified?

A

-History of two or more spontaneous pneumothorax sees on one side, if driver has not had a successful surgical procedure to prevent recurrence
-hypoxemia at rest
-chronic respiratory failure
-history of continuing cough with cough syncope

43
Q

Allergic rhinitis is rarely severe enough to limit ______ .

A

-certification
-best treated with non-sedating antihistamines or by using local steroid sprays that don’t interfere with driving ability

44
Q

When are patients with allergic rhinitis eligible for certification?

A

-Etiology is confirmed
-treatment safe and effective
-condition does not pose a risk to the safety of the driver and to the public

45
Q

For what period of time can a patient with a allergic rhinitis be certified?

A

-May be certified for up to two years
-on case-by-case basis, obtain additional tests

46
Q

When is a driver with allergic rhinitis not eligible to be certified?

A

-when there are complications and/or treatments that may impair ability to operate a commercial motor vehicle safely
-severe conjunctivitis affecting vision
-inability to keep eyes open
-photophobia
-uncontrollable sneezing fits
-sinusitis with severe headache
-medications cause sedation or other side effects that interfere with safe driving

47
Q

When can a driver with a history of anaphylaxis or life-threatening angioedema be certified?

A

-When successful measures to prevent adverse effects are implemented
-when you is a medical examiner believe the condition does not pose a risk to the driver in the public

48
Q

For what period of time can a patient with a history of anaphylaxis or life-threatening angioedema be certified?

A

-Two your maximum certification
-on a case-by-case basis, may obtain additional medical tests

49
Q

When is a driver with a history of anaphylaxis or life-threatening angioedema not eligible to be certified?

A

-No effective treatment regimen in place
-no successful prevention measures

50
Q

For what period of time can a patient with a history of asthma be certified?

A

-Two year maximum certification
-on case-by-case basis, obtain additional tests

51
Q

When is a driver with a history of asthma not eligible to be certified?

A

-Continual, uncontrolled, symptomatic asthma
-significant impairment of pulmonary function:
* FEV1 < 65%
* significant hypoxemia, showing up as partial pressure of arterial oxygen less than 65 mmHg

52
Q

When can a driver with a history of hypersensitivity pneumonitis be certified?

A

-Successful measures to prevent adverse effects are implemented
-you, as a medical examiner, believe the condition does not pose a risk to the driver in the public

53
Q

For what period of time can a patient with a history of hypersensitivity pneumonitis be certified?

A

-May certify for maximum of two years

54
Q

What follow-up care is needed for a driver with a history of hypersensitivity pneumonitis?

A

-on case-by-case basis, get additional tests
-needs continual medical oversight
-to alleviate symptoms driver must avoid exposure to the causative agent

55
Q

When is a driver with a history of hypersensitivity pneumonitis not eligible to be certified?

A

-You believe the nature and severity of the drivers medical condition endangers the health and safety of the driver and the public

56
Q

If you suspect a driver has obstructive sleep apnea, what is the next step? Can this driver have certification?

A

-Order a sleep study
-limited certification to keep the driver working until the sleep study is performed is appropriate
-this is a discretionary standard
-FMCSA recommendations for surgery or CPAP usage should be followed

57
Q

What are parameters that should be evaluated when considering certification intervals for drivers with obstructive sleep apnea?

A

body mass index, neck circumference, and comorbidities are a few of the parameters

58
Q

When can a driver with a history of obstructive sleep apnea be certified?

A

-Waiting period of one month after starting CPAP, if successful and compliant

-waiting period of three months after surgical correction with resolution of symptoms

-driver can also qualify if they have successful nonsurgical therapy with multiple sleep latency tests in the normal range or resolution compared confirmed by repeated sleep study

59
Q

For what period of time can a patient with a history of obstructive sleep apnea be certified?

A

One year maximum certification

60
Q

What follow-up care is needed for a driver with a history of obstructive sleep apnea?

A

-Driver must remain symptom-free
-driver must continue uninterrupted therapy and undergo yearly objective testing

61
Q

When is a driver with a history of obstructive sleep apnea not eligible to be certified?

A

-Hypoxemia at rest
any of the following chronic sleep disorder diagnoses disqualify a driver from certification:
* untreated symptomatic obstructive sleep apnea
* narcolepsy
* primary idiopathic alveolar hypoventilation syndrome
* idiopathic central nervous system hyper somnolence
* restless leg syndrome associated with excessive daytime sleepiness

62
Q

When a driver has excessive daytime sleepiness with unknown etiology, you can order an objective sleep test to determine the presence of a sleep disorder. You should consult with the drivers employer when making these final decisions. What are the names of some tests you might consider?

A

-polysomnography in controlled sleep lab
-napping tests:
* maintenance of wakefulness
* multiple sleep latency

63
Q

Describe the maintenance of wakefulness test. What is its purpose?

A

-Four sleep trials
-patient tries to stay awake as long as possible

Purpose: assess potential risk for work related injury in those with sleep disorders

64
Q

Describe the multiple sleep latency test. What is its purpose?

A

“nap study”
evaluates number of REM cycles and speed of falling asleep

Purpose: assess diagnosed severity of narcolepsy or idiopathic hypersomnia

65
Q

Describe the polysomnogram test. What is its purpose?

A

-Charts brain waves, oxygen saturation, vital signs, sleep cycle during sleep

Purpose: diagnose sleep apnea and other sleep-related breathing disorders

66
Q

Apnea is defined as occurring when respirations cease for more than _________ seconds.

A

10

67
Q

Hypopnea occurs when air flow decreases during respirations for more than _______ seconds.

A

10

68
Q

The apnea-hypopnea index is a way to try to describe severity of apnea and hypopnea that affect a driver who has a sleep disorder. What does it mean to say that the driver has a mild apnea-hypopnea index?

A

Patient has between 5 and 14 episodes of apnea or hypopnea per hour.

69
Q

What does it mean to say that the driver has a moderate apnea-hypopnea index?

A

Patient has between 15 and 29 episodes of apnea or hypopnea per hour.

70
Q

What does it mean to say that the driver has a severe apnea-hypopnea index?

A

Patient has 30 or more episodes of apnea or hypopnea per hour. Patients in this range meet criteria for being diagnosed with obstructive sleep apnea.

71
Q

What is cor pulmonale?

A

Secondary enlargement of the right ventricle caused by respiratory or cardiovascular disorders that affect the structure or function of the lungs.

72
Q

What is the most common respiratory cause of cor pulmonale?

A

hypoxic pulmonary vasoconstriction in patients who have chronic obstructive lung disease

73
Q

With the most common cardiovascular cause of cor pulmonale?

A

Pulmonary hypertension caused by heart failure

74
Q

What are common symptoms of patient with cor pulmonale might have that can affect driving?

A

Dizziness
Hypertension
Syncope
side effects of vasodilators

75
Q

When can a driver with a history of cor pulmonale be certified?

A

-diagnosis is confirmed and treatment has been shown to be safe and effective
-you don’t feel that the cor pulmonale or its underlying cause doesn’t affect safety of the driver or public safety

76
Q

For what period of time can a patient with a history of cor pulmonale be certified?

A

-two year max certification
-if you feel the driver need frequent monitoring, then certify for one yr or less

77
Q

What follow-up care is needed for a driver with a history of cor pulmonale?

A

-if driver has dyspnea at rest, order addt’l testing such as PFTs
- if FEV1 < 65% of predicted value, ABG should be obtained

78
Q

When is a driver with a history of cor pulmonale not eligible to be certified?

A

-you feel that the cor pulmonale or its underlying cause affects safety of the driver or public safety
-dyspnea at rest
-dizziness
-hypotension
- partial pressure of arterial oxygen less than 65 mmHg

79
Q

What is pulmonary HTN?

A

-condition in which pulmonary artery pressure is > 50% of systemic systolic blood pressure, regardless of the cause
-may occur with or without cor pulmonale
-is associated with increased risk for sudden incapacitation, whether primary or secondary pulmonary hypertension

80
Q

When can a driver with a history of pulmonary hypertension be certified?

A

-diagnosis confirmed
-treatment has shown to be safe and effective
-you feel the pulmonary hypertension or its underlying cause does not affect driver safety and safety of the public

81
Q

For what period of time can a patient with a history of pulmonary hypertension be certified?

A

-One year maximum certification
-determine on a case by case whether patient needs consultation

82
Q

When is a driver with a history of pulmonary hypertension not eligible to be certified?

A

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